Adverse cutaneous reactions associated with the newest antiretroviral drugs in patients with human immunodeficiency virus infection

Borrás-Blasco, Joaquı́n; Ruíz, A Navarro; Borrás, Consuelo; Mora, Elvira

doi:10.1093/jac/dkn292

Cited by 94 publications

(77 citation statements)

References 77 publications

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“…Differentiating between adverse consequences of HIV infection and toxicities of drugs used in its management may be challenging. However, following the use of a combination of ARV drugs, some distinct adverse drug events have been reported as case reports [9,10].…”

Section: Introductionmentioning

confidence: 99%

Adverse Events in HIV- infected Children on Antiretroviral Therapy at a Teaching Hospital in Lagos, Nigeria: A Retrospective Study

Oshikoya¹

2012

Adv Pharmacoepidem Drug Safety

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Background: Highly active antiretroviral therapy (HAART) program requires adequate monitoring of the potential adverse events to the antiretroviral (ARV) drugs. We investigated the ARV drug combinations prescribed for HIV-infected children and their suspected adverse events.Methods: This is a retrospective and descriptive study involving HIV-infected children less than 15 years old who received treatment at the APIN clinic, Lagos University Teaching Hospital (LUTH) in Nigeria. The case files of 80 patients initiated on HAART, between January 2008 and December 2009, were reviewed. Their demographics, clinical details and medication use, the prescribed HAART regimen, and the suspected clinical and laboratory adverse events were extracted. Results:The patients were female (46; 57.5%) preponderant with a median age of 3 (IQR: 1.1-6.0) years. Zidovudine-lamivudine-nevirapine (AZT-3TC-NVP) combination (74; 92.5%) was the most frequently prescribed first-line regimen. Thirty three patients changed their first-line HAART to abacavir-lamivudine-lopinavir boosted with ritonavir (ABC-3TC-LVP/r) (11; 33.3%), and zidovudine-lamivudine-abacavir-lopinavir boosted with ritonavir (AZT-3TC-ABC-LVP/r) (8; 24.2%) combinations. Of the 80 patients included in the study, 38(47.7%) experienced 142 adverse events. The most frequently experienced clinical adverse events were nevirapine-induced skin rashes (93; 65.5%), vomiting (19; 13.4%), and pallor (12; 8.5%). Macrocytosis (22/72; 30.6%), anaemia (6/72; 8.3%), and thrombocytopenia (2/72; 2.8%) were the commonest haematological adverse events associated with zidovudine. Conclusions:The HAART regimens used for HIV-infected children in this study have a good safety profile. Their few adverse events suggest a need for prospective pharmacovigilance to effectively monitor the toxicities of ARV drugs.

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Section: Introductionmentioning

confidence: 99%

Adverse Events in HIV- infected Children on Antiretroviral Therapy at a Teaching Hospital in Lagos, Nigeria: A Retrospective Study

Oshikoya¹

2012

Adv Pharmacoepidem Drug Safety

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“…9 We report a case of severe cutaneous reaction to darunavir/r and a successful desensitization protocol, as described previously. 12,13 The patient was a 41-year-old female, known to be HIV infected for 18 years. Her drug history contained double nucleoside reverse transcriptase inhibitors (NRTIs; zidovudine [ZDV] and zalcitabine [ddC]), combinations of different NRTIs with indinavir (IDV) and later nelfinavir (NFV).…”

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confidence: 99%

Hypersensitivity and Desensitization to Darunavir in a Case of HIV Infection with Triple-Class Drug Resistance

Lorber

Haddad²

2013

J Int Assoc Provid AIDS Care

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We report on a case of severe cutaneous reaction to darunavir/r and a successful desensitization protocol. The patient was a 41-year-old female, known to be HIV infected for 18 years and who had received several drug regiments in the past. As a consequence, her virus had triple-class mutations but was susceptible to darunavir/r. Her CD4 was 200 cells/mm 3 and HIV viral load 56,000 copies/ mL. Eight days after initiation of darunavir/r the patient developed a severe pruritic vesicular extended cutaneous allergic reaction which required cessation of all drugs. Due to the severity of the allergic reaction no rechallenge was done. After the patient's recovery, the virus was found to be susceptible only to maraviroc, raltegravir, and darunavir/r. Since darunavir/r was an essential component in treating this triple-class mutated virus, a desensitization protocol was applied successfully. Six months after desensitization, the patient is asymptomatic, compliant, and her HIV viral load remains at <20 copies/mL. Keywords antiretroviral therapy, hypersensitivity reaction, darunavirAntiretroviral therapy (ART) in HIV-infected individuals has changed the course of the disease from a lethal to a chronic, manageable condition. Antiretroviral therapy has improved over the years, with more potent and less toxic drugs. Patients who were infected for several years and were treated with old generation ART developed a series of adverse reactions such as neuropathy, lipodystrophy, anemia, cytopenia, central nervous system involvement, and triple-class ART resistance, in many cases due to noncompliance.Darunavir, a protease inhibitor (PI) with high genetic barrier, is highly effective in patients who developed multidrug-resistant HIV, including cases resistant to older PIs. 1Darunavir contains a sulfonamide moiety and should be used with caution in patients with a known sulfonamide allergy. 2One of the serious adverse events seen in patients undergoing ART is drug hypersensitivity reaction. Such an event may be a serious and sometimes even a lifethreatening condition limiting the number of drugs available for the future management of the HIV-positive patient. Several antiretroviral drugs have been described to cause skin reactions.3-7 Amprenavir (APV) is a PI that most frequently produces adverse cutaneous reactions (in up to 28% of patients),8 but mounting information is also accumulating concerning darunavir. Of note, information on darunavir is mostly from clinical trials due to the limited time that elapsed since its approval.In a phase III clinical trial that randomized 604 patients treated with darunavir/ritonavir (darunavir/r) or lopinavir/ritonavir (LPV/r) plus an optimized background therapy, 16% of the patients who received darunavir/r developed a rash compared to only 7% in the other arm who received LPV/r. Two of the patients who received darunavir/r had a serious rashrelated event requiring treatment cessation, whereas patients who received LPV/r did not develop any serious skin events. 9Another large, open-label ...

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“…Therefore, it is necessary to develop and get approval of novel antiretrovirals as soon as possible in order to avoid these cutaneous adverse reactions. 7 Our study showed that the major regimen induced dermatological complications presenting in our study set up included rashes, itching, SJS, pigmentation of nails, skin hyper pigmentation respectively. The morbilliform eruption, often referred to as a maculopapular rash, is the most common type of reaction after treatment.…”

Section: Discussionmentioning

confidence: 56%

Monitoring cutaneous adverse drug reactions in patients on TDF+3TC+EFV: a single centre experience

Era¹,

Mukherjee²,

Saha³

et al. 2017

Int J Basic Clin Pharmacol

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Background: HIV-infected patients initiating antiretroviral therapy may manifest a wide variety of ADRs ranging from trivial manifestation, such as rashes, pigmentation, to severe life‑threatening reactions, such as Steven–Johnson syndrome, toxic epidermal necrolysis. The present study thus monitored cutaneous adverse drug reactions in patients on first line antiretroviral regimen comprising of tenofovir disoproxil fumerate, lamivudine and efavirenz as a three drug-combination.Methods: A prospective observational clinical study was carried out for a period of one year among PLHIV receiving TDF+3TC+EFV as first line regimen in the outpatient setting of a nodal ART centre of eastern India.Results: The major regimen induced dermatological complications presenting in our study set up included rashes, itching, SJS, pigmentation of nails, skin Hyperpigmentation. The morbilliform eruption, often referred to as a maculopapular rash, is the most common type of reaction occurring after treatment initiation.Conclusions: Adverse drug reactions are one of the most common public health concerns, which influence patients' treatment options along with health care costs.

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Adverse cutaneous reactions associated with the newest antiretroviral drugs in patients with human immunodeficiency virus infection

Cited by 94 publications

References 77 publications

Adverse Events in HIV- infected Children on Antiretroviral Therapy at a Teaching Hospital in Lagos, Nigeria: A Retrospective Study

Adverse Events in HIV- infected Children on Antiretroviral Therapy at a Teaching Hospital in Lagos, Nigeria: A Retrospective Study

Hypersensitivity and Desensitization to Darunavir in a Case of HIV Infection with Triple-Class Drug Resistance

Monitoring cutaneous adverse drug reactions in patients on TDF+3TC+EFV: a single centre experience

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